A study by the American College of Physicians (ACP) found that overuse of antibiotics, aggressive non-palliative treatment in patients with limited life expectancy, treatment of chronic pain, and dietary supplements may be the most frequently used low-value treatment interventions used by doctors. The study was published today in Annals of Internal Medicine.
The study is based on a random survey of 5,000 ACP member physicians asking them to identify two treatments frequently used by internists but unlikely to provide High Value Care to patients.
Many current clinical guidelines recommend against routine use of the treatments identified in the survey, including antibiotics for upper respiratory tract infections, the use of opioids for chronic pain management, and dietary supplements.
Despite evidence highlighting the efficacy and efficiency of generic medications or the lack of evidence supporting the use of newer and more expensive medications compared to older medications, physicians continue to prescribe more costly treatments.
The list identified in this survey is not inclusive and does not highlight many clinical interventions for which the prevalence of inappropriate use and harms is well-supported in the literature.
"While many current clinical guidelines recommend appropriate care, the results of this survey may reflect intrinsic motivations to err on the side of treatment rather than 'doing nothing,' " says lead author Amir Qaseem, MD, FACP, PhD, Vice President, Clinical Policy, ACP, and Chair of ACP's High Value Care Task Force. "However, as health care shifts to a value driven system, this study shows that doctors are willing to critically assess their own clinical practice."
ACP's High Value Care recommendations help doctors and patients understand the benefits, harms, and costs of tests and treatment options for diseases so they can pursue care together that improves health, avoids harms, and eliminates wasteful practices. Value is not merely cost. Some expensive tests and treatments have high value because they provide high benefit and low harm. Conversely, some inexpensive tests or treatments have low value because they do not provide enough benefit to justify even their low costs and might even be harmful.
Earlier this year, ACP and the Centers for Disease Control and Prevention issued advice for prescribing antibiotics for acute respiratory tract infections in adults.
ACP also has High Value Care and Best Practice Advice for breast cancer screening, cardiac screening, cervical cancer screening, colorectal cancer screening, end-of-life care communication, upper endoscopy for gastroesophageal reflux, generic medications, inpatient glycemic control, hematuria, ovarian cancer screening, prostate cancer screening, and evaluation of patients with suspected pulmonary embolism.
In 2012, ACP published "Appropriate Use of Screening and Diagnostic Tests to Foster High Value, Cost-Conscious Care," an opinion article that identified 37 common clinical situations relevant to internal medicine in which screening and diagnostic tests are often used in ways that provide little or no benefit to patients.